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HomeMy WebLinkAbout03-27-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of GERTRUDE I. MITCHELL File Number 21 09 (~.~`T also known as ,Deceased Social Security Number 204-18-0883 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' OR 'B' BELOW.) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the EXECUTRIX named in the last Will of the Decedent dated 8/6/07 and codicil(s) dated none John J.P. Mitchell and Christine McCleery have renounced their right to serve as Executors (State relevant circumstances, e.g., renunciation, death of executor, etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instrument(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: B. Grant of Letters of Administration (If applicable, enter: c. t. a.; d. b. n. c. t. a.; pendente liter durante absentia; durante rninoritate) Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If Administration, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) Decedent was domiciled at death in Cumberland County, Pennsylvania, with his /her last principal residence at 509 Colonv Road Camn Hill PA 17011 Hanpden Township (List street address, town/city, townshrp, county, state, zip code) Decedent, then 85 years of age, died on 2/17/09 at 509 Colonv Road Camn Hill Hampden Township PA 17011 Decedent at death owned property with estimated values as follows (If domiciled in PA) All personal property $ 30,000.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ 150,000.00 Hampden Township situated as follows: Wherefore, Petitioners) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to the undersigned: Signature Typed or printed name and residence n ~^'~- tom--- Joanne Nolan 301-365-5924 7710 Savannah Drive Bethesda MD 20817 Page 1 of 2 Form RW-Ol rev. 10.13.06 (COMPLETE LN ALL CASES:) Attach additional sheets if necessary. Y a W Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirm~ed'a]nd~subscribed before me the Q,L_' _ day of Signature of Personal Representativ Joanne v n ~ Signature of Personal Representative a ~ ~ t~~ Z ~7 ~ '~~= fTi N - J Si nature o Personal Re resentative , - '' ='~ - ~ + ! ~' For the egister S f p - "~ ~ ~ ~ -- /..'' ~ ~ c':a :'~ File Number: 21 - ~'~ ~ U ~`~ to Estate of GERTRUDE I. MITCHELL ,Deceased Social Security Number: 204-18-0883 Date of Death: 2/17/09 AND NOW, ~ , 2009 , in consideration of the foregoing Petition, satisfactory proof having been presented before me, I ' ECREED that Letters Testamentary are hereby granted to ~+ in the above estate and that the instrument(s) dated n " ~(1' n 7 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent FEES Letters ............................. Short Certificate(s) ............ Renunciation(s) ................ .... r Register of Wills -~a/'~[~ j~ _ Attorney Signature: ~.~ 7~ ~~~ J°", l(~J Attorney Name: Seth T. Mosebev .... $ TOTAL ............................. Supreme Court I.D. No.: 203046 Address: 10 East Hiah Street Carlisle PA 17013 Telephone: 717-243 -3 3 41 Form RW-02 rev. 10.13.06 Page 2 of 2 .- --,- - LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. ~P 15187345 Certification Number D`' B 1 2009 Local egistra ate Issued n ~ -; _ ~ ..~! ' ~-' . ~ r C7 ~ ~ ;.r rr'1 tV t . ~ ^ -,..i r i J 1 - c' , C .~ ) i_? -t-t - -p ---f ~ - ~'~) ~i ~ - -_- ~ - ~ ~~ C.J ~ - --, _p CJ REV nr2ooe COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ' (PRINT IN MANENT CERTIFICATE OF DEATH rCK INK ($CC IfIStrUCtIOF1S BFIrJ C'XBRIPIBS OIT rEVBr$E~ ;STATE FILE NUMBER 1. Name d Decedent(First, middle, last sutfn) 2. Sex 3. Sodel Sacunry Number 4. Dale of Death (MOnm, day, year) Gertrude I. Mitchell male 204 - 18 '-- 0883 February 17, 2009 5. Age (Last Birnday) Urxler I year Untler I day 6. Date of Birm (Mash, day, year) 7. Birtltplace (Cdy and state a f toad) 8a. Place d Deem (Check onty one) - 85 "'°'"~ °"` "°-' ""'"'" 15, 1923 Mahoney City, PA "°'"'~' 01~` Vrs. ^ Inpenenl ^ ER / ONpalient ^ OOA ^ Nursing Home ~ Residence ^Other -Specify: 3b. County d Deem Bc. City, Born, Twp. of Death !b. Fadlky Name (N not insUlutlon, give sued aM number) 9. Was Decedent of Hislank Origin? No ^ Yes 10. Race: American lafan, Black, While, etc. Gtmberland Hampden Ztap. 509 Colony Rd. (If yes, specny Cuban Mexican, Puerro Rzan, etc.) (Speciry+l White 11. Decedents Usual lion Kind a work d are M' mast d wo+k~ INe. Do not state relinM 12. Was Decedent ever In the 13. Decedent's Education (Spiny say highest Breda canp lated) 1a. Mad191 Status: Marneq Never Marred 15. surviving Spo use (lf wile, give maiden name) Kintl d Work KirM d Buskass I Industry U.S. Armed Forces? Elements,y~ /Secondary (0.12) Calege (1.1 or 5*) Widowed, DVO~ (Sf~'M Widowed Clerk US 1Yeasury ^Yea [BNp 1L - 16. Decedent's Mailing Address (Street city /town, state, ziP coda) 509 Colon Rd. y Decedent's Did Decedent O LNe n a 17c.g] Yee. CNIwdeM Lived in ~ Twp. Actual Reatlence 17a State p ~ T hi ? - PA 17011 Cam Hill owns p L~ ^_, v 17d ^ No, Decedent Lived wdhin 176. Caunry Cl~erl8nd , p Acual amts d city /sore 1B. Ferret's Name (First mode, Wst six) 19. Mother's Name (First, mirlde, maiden sarame) Edward Walsh Gertrude Hoban Zoe. Inramanrs Name (Tree! Pnnt) 206. Inbrmenrs ARaikrg Adkeee (sheet dh r town, state, zip cofei Joanne Nolan 7710 Savatu~ah Dr., Bethesda, MD 20817 21a. MethOtl d D'sposnicn ^ cremation ^ Ooredon 21b. Gate of Dispoainat (MOdh, day. yeary 21c. Place of OuPOaitari (Nana d cemetery, denatory or otlar place) 21d. Location (city 1 town, slate, zip code) - ~I Bartel ^ Remp."'~^ srsle Wee crnaatbn a oonenon Autlrorized Februal-V 21 2009 ` to of Heaven CgneteYV MechaniCSbur PA ~ ^ Omer - Spsd/y t by Medal Exanlmer f Coroner? ^ Yes ^ No ~ ! `~. ' f • 22a. d Faaml Servke I.iceraee (a uch) 22b. (losses Number 22c. Name and Adtlreas d Fedlgy M ers-Hamer FLIC1erA:L Home - ~ 14819 y `~7 Complde Items 23e-c say when rxarntying 23a. To the bast d my knowbdge, at me lime, dale and place staled. (Signature and line) 236. Lkenw tlunbar 23c. Dale Sgnetl (Month, day, year) phryirian re rid availshk 91 t'ma d tleem to terry cause a deem. ~.~.~ v.l ff Ny r'~. N J I, S 3 z L r;~1s7 1 7 z C'C7 ' Items 21-26 must be cortpletetl by person 2d. Time of Death 25. Date Praatxtced Dead (MOdh, day, year) 28, Was Case Referred to Medical Examiner /Coroner for a Reason Other than Crematbn a Donation? wTO pronaxges deem. ->`~ ~j r{ AM. `> ~ '( ~ ~ [~~ ^ Yea ~] Na CAUSE OF DEATH (See Instructions aad sxamplas) r Approximate mtenel: Part II; Enter other nl mndlllbns coddMnia b tleam, 2n. Did Tobacco Use Codribule b Deam? Nam 27. Pad L Enter me aain d evems - dseeses, injuries, a wmp6calbm -that drecYly caused the death. W NOT enter tetmaal stems such as cardec artari, r Onset to Death a ventnculaz fibraatbn without showing me abbey LiSi only ore cause on sash ins r respkebry artesl but not resuninq in the urdertying cause ghen in Pad I. ^ Yes Probabty . , . ' ^ Unknown aeese a x ~ i Wcprldtlon ~ pAx gin IFx hl)d deb __~ a. =~J Ah.) 4 T t 29. If Fenale~ Due to (or as a consequence oQ: ~ 1 pregnant wimin Past year Sepenaaly tat cartddbra, N arty, 6. ~ ~ /~ ~ ^ Pregnant at Time of deem katina b me cause flied on ins a. Due to ar as a w F_nlflr me UNDERlY1NG CAUSE ( nsaTUence o11~ ~ ^ Not Oregnenl. but preened wimin 42 days (dseese a sMxY mat innialetl tla c ; S C I ZI_ rt t f U events relWbrig m seam) LAST of death . Due to (a as a consequence of)' r ^ Nd pregiant Oa pregnant 43 days to t year d. 1 balsa tleath ^ Unknown it prepanl wnikn the pest year 30a. Was an ANOpsy 30b. Were Autopsy Findings 31, Mamer a 32a. Dale d Injury (Mann, day, year) 32b. Descdbe How Injury Oxurred 32c. Place of Injury: Horne, Farts, area, Famory, Padormed? Avana6k Pdor to Completion ~' ^ ~'b~ Ollke BuiMing, ek, (speary) d Cause d Deem? " ^ Yes ^ Yes ~-'Flo/' ^ ~~nt ^ Pendng Invesngetbn 32d. Tnne a Injury 32e. Injury al WoM7 321. II Transponalion Injury (~N) 32g. Locenon a lnjuy (Street ciN I town, state) ^ SuipOe ^ Coub Nd be Daermbed ^ Yes ^ No ^ Ddvaz / Operate ^ Passenger strron M Omer -Specify: 33a. Certifier (sack mq one) 33b. SgnaNre antl Tihe a • Ceditying phyaielrt (Physcian cenilyirlg cause d deem wren arotlar physiden has prorauncM deem azd complaetl Item 231 pt To the best d toy krowktlge, death occurred due io the reuse(s) end manner ore alaPod_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ yy - • RonouncMg and artityirrg physicfen (Physician both Praaultdng death and caztltying to cause d deem) T h d d d h h d d t l s d l d ~l ^ 33c. License Number 33tl, Date Signetl (MOnm, tlay, yaarl _ _ _ _ _ _ . a t e best e gn, eat OggUmed et t e ma, a e, and P att, art ce tp I e cause(s) an mamler ore stated _ _ _ _ _ _ _ _ _ _ m! V S a I ~-, 1 >„~ `. ~'] I I ((/d ,~ P Madttl Examner I Coroner On the Weis d examinetlon and! or InvestigHbn, fn my oplnlon, death rKCUrted at tM lime, dale, end place, end due to the cease(s) and manner ea alekd_ ^ 34 Name antl Adtlress of Person Who Completed Cause of Deam (Item 27) Type I Print t ' mbe f 35 R Si ut N 36 D l d R~ ~ Y z'"Jt ~ C~ k (^^v Z 2 'a U rar r / / / . egs s g~ ure a u ( . e 1 ay, Year) YP ~Z.nba'x lU~at( !1c.ln Diepoenron Pennlt No. 0332329 . _ d ~-~%q- v~~y . 9 ~ r N C'7 ~ a.D _t 1 - +~~~ LAST WILL AND TESTAMENT ~'~ 7, ~" `~ ~? } ~ ~ OF -' c.,-i ~ -, - - - -~ ~ ; --ti ; GERTRUDE I. MITCHELL --~ ~, c,~ ' `l' . --~ _ .~ . "O .3 O , W I, GERTRUDE I. MITCHELL, of Hampden Township, Cumberland County, Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me at any time made. ITEM 1. I direct that all inheritance and estate taxes becoming due by reason of my death, whether such taxes may be payable by my estate or by any recipient of any property, shall be paid by my Executors out of my residuary estate, as an expense and cost of administration of my estate. My Executors shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. In the absolute discretion of my Executors, they may pay such taxes immediately or may postpone the payment of taxes on future or remainder interests until the time possession thereof accrues to the beneficiaries. I also direct my Executors to pay the expenses of my last illness and funeral expenses from the property passing under this Will as an expense and cost of administration of my estate. ITEM 2. I give and bequeath the sum of Eight Thousand (;$8,000.00) Dollars to my grandson, NATHAN GILLESPIE, of Mechanicsburg, Pennsylvania if he survives me. ITEM 3. I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever nature and kind and wheresoever the same shall .. be at the time of my death unto my children, JOHN J.P. MITCHELL of Mechanicsburg, Pennsylvania, SUSAN HIMMELSBACH of Millersville, Pennsylvania, CHRISTINE McCLEERY of Quincy, Illinois, AMY STEINER of Mechanicsburg, Pennsylvania, MARY BETH GARLAND of Camp Hill, Pennsylvania, and JOANNE NOLAN of Bethesda, Maryland, equally, share and share alike. In the event that one or more of my aforesaid children should predecease me, then his or her share shall be distributed to his or her children, if any, in equal shares, or if none, to my surviving children in equal shares. ITEM 4. In addition to the powers conferred by law, my Executors shall have the following powers: (a) To retain in their absolute discretion and for such period as to them shall seem advisable, any and all assets constituting my estate, without liability for any loss incurred by reason of the retention of such assets. (b) To change investments and properties, and to invest and reinvest all or any part of the corpus of my estate, in such securities, investments, or other property as to them seem advisable and proper, irrespective of whether the same are authorized for the investment of estate funds by the laws of the Commonwealth of Pennsylvania. (c) To sell all or part of the property which at any time may constitute a part of my estate, at such time, upon such terms, for cash or on credit, with or without security, in such manner and at such prices, either at public or private sale, as to them shall seem advisable and proper, and to execute good and sufficient deeds and bills of sale therefor. -2- (d) To lease any property held by them and for th.e duration of the term, irrespective of the provisions of any statute or of the termination of my estate; and to mortgage, pledge, collect, convert, redeem, exchange, or otherwise dispose of any securities or other property at any time held by them. (e) To borrow money, whether to pay taxes, exercise subscriptions, rights, and options, pay assessments or to accomplish any other purpose of any nature incidental to the administration of my estate, and to pledge any securities or other property held by them as security therefor. (f) To enforce any bonds, mortgage, or other obligations or liens held hereunder; to enter upon such contracts and agreements and to make such compromises or settlements of debts, claims, or controversies as they may deem necessary or advisable; to submit to arbitration any matter or difference; to vote personally or by proxy any shares of stock which may at any time be held by them hereunder. (g) To consent to the reorganization, consolidation, merger, liquidation, readjustment of or other change in any corporation, company or association, or to the sale or lease of the property thereof or any part thereof, any of the securities or other property of which may at the time be held by them thereunder, and to do any act or exercise any power with reference thereto that may be legally exercised by any person owning similar property in his own right, including the exercise of conversion, subscription, purchase or other options, the deposit or exchange of securities, the entrance into voting trusts, and the making of agreements or -3- subscriptions which they may deem necessary or advisable in connection therewith, all without applying to any court for permission to do so, and to hold, redeem, sell or otherwise dispose of any securities or other property which they may so acquire, irrespective of whether the same be authorized for the investment of estate funds by the laws of the Commonwealth of Pennsylvania. (h) To cause to be registered in their names as Executors hereunder, or in the names of their nominees without qualification or description, any securities at any time held in my estate. (i) To determine the manner in which the expenses incidental to or connected with the administration of my estate hereby established shall be apportioned as between income and principal. (j) To carry out agreements made by me during my lifetime, including the consummation of any agreements relating to the capital stock of corporations owned by me at the time of my death, and including the continuation of any partnership of which I may be a member at the time of my death whenever the terms of the partnership agreement obligate my estate or personal representative to continue my interest therein, and to enter into agreements for the rearrangement or alteration of my interests or rights or obligations under any such agreements in effect at the time of my death. (k) To apportion extraordinary and stock dividends received by them between income and principal in such manner as they may see fit; provided, however, that all rights to subscribe to new or additional stock or securities, and all liquidating dividends shall be deemed to be principal. -4- My Executors may freely act under all or any of the powers of this Agreement given to them in all matters concerning my estate hereby established, after forming their judgment based upon all the circumstances of any particular situation as to the wisest and best course to pursue, without the necessity of obtaining the consent or approval of any court, and notwithstanding that they may also be acting as an individual, or as an agent for other persons as an individual, or as an agent for other persons or corporations interested in the same matters, or may be interested in connection with the same matters as stockholders, directors or otherwise. The powers herein granted to my Executors may be exercised in whole or in part, from time to time, and shall be deemed to be supplementary to and not exclusive of the general powers of executors pursuant to law, and shall include all powers necessary to carry the same into effect. The enumeration of specific powers herein shall not be construed in any way to limit or affect the general powers herein granted. ITEM 5. If any income or principal shall be payable to any beneficiary who is under the age of twenty-one (21) or shall be under a legal disability or in the sole judgment of my Executors or Trustee shall otherwise be unable to apply such payments to his or her own best advantage (hereinafter referred to as minority or incapacity), my Executors or Trustee shall hold such income and principal during minority or incapacity and shall apply such income and principal to the health, maintenance, support and education of such beneficiary during minority or incapacity without the appointment of any guardian or committee or any authority of court and shall make all or any portion of any such payment in any one or more of the following ways: -5- r (a) Directly to such beneficiary. (b) To the legal guardian or conservator or custodian under the Uniform Transfers to Minors Act of such beneficiary. (c) To a relative of such beneficiary to be expended by such relative for the benefit of such beneficiary. (d) By themselves, expending the same for the benefit of such beneficiary. Any remaining income and principal to which such beneficiary shall be entitled shall be paid and distributed to such beneficiary on the termination of minority or incapacity. ITEM 6. I hereby nominate, constitute and appoint my son, JOHN J.P. MITCHELL, my daughter, JOANNE NOLAN, and my daughter, CHRISTINE McCLEERY, as Executors of my estate. It is my intention that my Executors serve without compensation as a service to and for the benefit of themselves and their siblings as beneficiaries hereunder. My Executors are specifically relieved from the duty or obligation of filing any bond or bonds. ITEM 7. For the convenience of my Executors, I note that this Will has been prepared by Ronald D. Butler, Esquire and the Butler Law Firm. -6- •. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, this ~,~` day of ~~; , 2007. J Gertrude I. Mitchell WITNESS: (SEAL) ~ar111~ ~ residing at ~~ ~ ~Vo~~n~ Q.~r^, ~ C\~, ~ i ~ a°St~ ~1 \~ 0.~ L~~ residing at ~~~ ` r'1 O ~ ~~ ~C ~ ~~ -7- *; ~~ K COMMONWEALTH OF PENNSYLVANIA J SS. COUNTY OF DA~-IIN C (~jj~(CF.~I~ ) e, GERTRUDE I. MITCHELL, an... ..a,.- , and ~ ,the estatrix and the witnesses respectively, whose names a signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly (or willingly directed another to sign for her) and that she executed it as her free and voluntary act for the purpose therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of their knowledge, the Testatrix was at that time eighteen years of age and older, of sound mind and under no constraint or undue influence. Gertrude I. Mitchell l Witness Witness Subscribed, sworn to and acknowledged before me by GERTRUDE I. HELL, the Testatrix, and subscribed and sworn to before me by ,~ this ~Q''t~' day of My Commission Expires:/~~ n ~ ~S ~ c~~/o~~ 1 COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL SUZANNE M. DEDERER, Notary Public Camp Hill Boro, Cumberland County My Commission Expires Aug. 20, 2009 -8- --- 03/0912009 12:12 717-243-1850 MARTSON LAW RENUNCIA,'~'IQN R)rGISTER OF WILLS CUMBERLAND COUNTY^f,N^PENNSYLVANTA ` ~ W ! PAGE 02103 rte, t7 0 c © ,o --- -; _r r-r~ tU ~-- .:~_ ,;_~ ,_ . -~ - _ __ ~~'~-: ---, ,., -n - { ;v--, ~ 1~; _~ Q~ .~ , W Estate of GE.RTRUDE_I._MITCHELL _, , ,Deceased I, ).P. MITCHELL , in my capacity/.relation9hip as (Prior Namr,J ' EctrroR of the above Decedent, hereby renounce th.e right to administer the Estate of the Decedent and respectfully re+~uest that Letters be issued to ,LOANNE NOLAN _ _ ~ ~ ~ ~d ~ (Date) Fxetui!ed iJi RBgiSterrs Offtce Sworn to or aFt~rme. and subscribed bef r- me this y of ~(~lY~`~1 - - Deputy for Re,,aister of ~Vi.lls Fw~m RW-Ob rev. l fl. !3. R6 ~ , (Si, tureJ $39 RIDGEWOOD DRNE _ (Street Addrr..ssJ ~~ CSBURG (ay, Srars, ZipJ Execrcted nut of,Register`s Offic.~ Before tl~e undersigned personally appeared the party executing this renunciation. and certified. that he or she executed the rerun ation for the purp s sta ed within on t ' ~ day of otary Pu lie y Commission Expires: i~2~j . !3~ o~lc~ (SignatU*e and SCaI of Notnry or other official qu~Iified to adminivtcr oaths, Show date of exptmtioh of Notary's Cnmmisaion.) COMMONWEALTH ~~FF PENNSYLVANIA Notarial Sea! Jessica L. Grote, Notary Pubfic Mechanicsburg Born. Cumberland County My Commission ~x~ires Feb. 13, 2012 Member, Pennsyiuania Nssccatior~ of Notaries 03/09/2009 12:12 717-243-1850 MARTSON LAW PAGE 03/03 ra 0 ~~ruivc~.~~c~aN REGISTER pF W1LLS CUMBEItLArTD COUN'X'Y, PCNNSYLVANi.A ~1- C~ _ D~-°~ c~ ~ l - O ~.O - ` i ~ - ' ~ ~ 1 ~ ~ ~ 1. ~. t < ~.~,~. . _ ~ - = ~ . -, ~:~ ~ , _ ~, ~ : _ ~ ~ W - ~ ~ Estate of GERTRUDE I, MITCHELL ,_,_„ ,_,,,_, Deceased Z, CHRISTINE MCCLEERY_ , in my capacr.ty/relationship as (Print NamF) ~XECUTR1x of the above Decedent, hereby renounce the right to administer the 1~state of the Decedent and respectfully request that Letters be issued to JOANNE NOi eH (.Hatt.) .Executed i~r Register's Office S:i~orn to nr affL*med and subscribed before the this day of ,~, {Sl~natetrCJ 2b41 ORSE (Street AdtJrCSS) UINCY IL 62305 _ (Cify, State,1.ipJ L'xecuted out o, f .Register's Office Before the undersigned personally appeared the party executing this renunciation and eerti f ed that he or she e~cecuted the renunci t~ozz for the purposes stated within on this ~~' day of!u~,,,-, , ~2 ,~~ . Deputy for Register of Wills Form !llir fttS rev, 10.13.Oh Notary PubIi.c My Commission Expires: ~ - ~ ~ ~ O `~ (Sign¢huc and Senl of Notary or other O11ioiD1 qufllificd to adminisler oaths. Show datC o'f expiYation of Notary's Commission.) OFFICIAL. SEAL SARAFI lilltr'LLMAN NOTARY PUBLIC, S1i4TE OF ILLINOIS MY COMMISSION EXPIRES 6.20-2009